Orgasm Headache is a frightening experience.
It can also affect physical relations between intimate partners, as one partner will inevitably be put off by the threat of severe headache.
Sex headaches can also occur during masturbation, so the term "Primary Headache Associated with Sexual Activity" is now recommended by the International Headache Society Classification.
Only in a minority of cases is it a sign of serious disease.
However, a first episode of orgasm headache (which is classically an explosive sudden severe headache right at the point of climax) does require investigation.
It is estimated that the risk of serious disease is low, but Subarachnoid Haemorrhage occasionally occurs during sexual activity.
One estimate is that 4% of subarachnoid haemorrhage occur during sex. However, subarachnoid haemorrhage occurs about once per 10,000 people per year, so sex related subarachnoid haemorrhage only occurs, at most, about 4 times per million people per year.
Even today, people are still a bit shy discussing the symptom.
I have made diagnoses after people who have talked to several doctors about a headache occurring suddenly in the "late evening".
Only when directly asked, "Was it a headache during sex?" was it possible to make the diagnosis!
As a doctor, you need to be aware of this diagnosis, so you need to ask your patients appropriate questions when taking a headache history.
As a person with this headache, make sure you are not shy of telling your doctor what you were doing when your severe headache occurred.
If we are agreed on this, we are more likely to get the correct diagnosis, exclude serious disease and get an appropriate treatment.
Orgasm headache is often discussed in the context of other Exertional Headaches.
What Types of Orgasm Headache Are There?
There are two sorts of sex headache, and this headache can also occur during masturbation:
- Pre-orgasm headache - 25% of sex headache
Pre-orgasmic headache is a dull pain in both sides of the back of head (occiput) and jaw during the build up in sexual excitement. It usually resolves once sexual activity is completed.
- Orgasm headache - 75% of sex headache
Orgasmic headache is a sudden severe headache i.e. thunderclap headache which is usually explosive: acute-severe-maximal-at-onset. The severe pain last a few minutes, maybe a few hours at most, and then resolves.
Both types are thought to be provoked by the physiological changes produced by exercise.
It is not certain why exertional headache is so sore and so sudden in onset.
Most authorities, however, think this pain may be a form of migraine. The pain of migraine is now known to be a type of inflammation of the pain-sensitive lining of the brain - the meninges.
I find it hard to see how this inflammation could appear so quickly and so painfully in sex headache.
My own theory is that exertion either causes a sharp increase in intracranial pressure (intra = inside; cranial = head), or causes a Reversible Cerebral Vasoconstriction Syndrome - sudden painful spasm of brain arteries.
However, I am not able to provide any evidence, other than anecdotes from my own patients' stories.
There are several causes of headache during sex but most occur without a cause ever being detected.
If a serious cause has been excluded and sexual activity headache recurs, there are some specific headache treatments available.
None of these treatments has been put through a formal scientific trial, but they are widely regarded as having the potential to offer some relief.
These medications must only be used following consultation with your doctor.
This really needs to be taken at a migraine prevention dose eg 40mg three times daily, but a side effect of this in men is a reduced sexual drive, which is self-defeating!
Taken at a dose of 25-75mg about an hour prior to anticipated sexual activity. This drug has significant side effects including risk of worsening asthma and causing a perforated ulcer in the stomach.
- A triptan drug eg Sumatriptan
Taken at a dose of 50 or 100mg an hour prior to sexual activity, this might reduce the risk of a severe headache.
Orgasm Headache References
Frese A et al. Headache Associated with Sexual Activity. Neurology 2003; 61:796–800. (Free Abstract only)
A Chakravarty Primary headaches associated with sexual activity—some observations in Indian patientsCephalalgia 2006:26:202-7 (Free Abstract only)
A Frese et al. Headache associated with sexual activity: prognosis and treatment options.Cephalalgia 2007;27:1265-70 (Free Abstract only)
Biehl K et al. Comorbidity of migraine and headache associated with sexual activity.Cephalalgia 2007;27:1271-3 (Free Abstract only)
Keyrouz S et al. Call-Fleming Syndrome and Orgasmic CephalgiaHeadache: The Journal of Head and Face Pain 2008;48:967-71(Free Abstract only)
Randolph W et al. Orgasm and MigraineHeadache: The Journal of Head and Face Pain 2001;41:512-4. (Free Abstract only - describes relief of migraine by orgasm)
Valenca et al. Cerebral vasospasm and headache during sexual intercourse and masturbatory orgasms. Headache 2004;44:244-8 (Free Abstract only)
Some of these may, at some point in the future appear free online via pubmedcentral.
Orgasm Headache is just one of Many Headache Types
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